Barriers to Advance Directives

Abstract Background: Advanced directives (ADs) are legal documents that allows an individual to document their specific wishes for medical care should they be unable to speak for themselves. The use of advanced directives has implications directing the course of end-of-life care affecting both the cost and direction of care. Advance directives can clarify confusion and provide guidance, but their implementation is not clearly defined within the healthcare system. Despite their implications, multiple surveys indicate these documents have limited use within the United States for reasons that are not easily isolated including lack of knowledge of advanced directives and lack of opportunity to complete advanced directives. Objective: This literature review sought to synthesize existing research on AD utilization to identify barriers to the use of ADs. It also sought to identify the implications of these barriers to nurses throughout the healthcare system. Methods: Data was collected from CINAHL Complete, PubMed, PsychInfo using search terms “advance directive”, “barrier”, and/or “completion” between 2006 and 2016. Additional ancestry searching and citation-index searching was performed to add depth in reviewing seminal works. Results: The review of literature revealed recurring themes of patient and provider reluctance, readiness, attitudes, time constraints, knowledge deficit, lack of opportunity, and lack of comfort with the subject of ADs all contributed to limited completion of ADs. Conclusion: The findings suggest that barriers to ADs are complex and multifaceted. Limited research on overcoming these barriers exists. In the future, targeted interventions to individual barriers should be addressed to determine what interventions can increase the completion of ADs. Advance directive, living will, barrier, completio